Core Concepts in Pharmacology Second Edition

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Vitamins, Minerals, and Nutritional Supplements
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Vitamins

• Essential substances needed in small amounts to
  maintain homeostasis
• Usually enough in the diet
• Vitamin therapy is beneficial to patients
• Having a low or unbalanced dietary intake
• Who are pregnant
• Taking folic acid prior to conception and during
  pregnancy can prevent a certain type of birth
  defect
• Experiencing a chronic disease
• Who vigorously exercise

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Characteristics of Vitamins

• Human cells cannot produce vitamins (except
  vitamin D)
• Inadequate amounts of a vitamin will cause
  metabolism to be disrupted and disease will result

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Functions of Vitamins

• Vitamin B complex - coenzymes essential to
  metabolic processes
• Vitamin A - precursor of retinal needed for
  normal vision
• Vitamin D - regulates calcium metabolism
• Vitamin K - needed to produce prothrombin

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Water-Soluble Vitamins - Dissolve in Water

• Examples - vitamin C and B vitamins
• Absorbed with water in the digestive tract
• Easily dissolve in blood and body fluids
• Excess cannot be stored, excreted in urine
• Must be ingested daily

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Fat-Soluble Vitamins - Dissolve in Lipids

• Examples - vitamins A, D, E, and K
• Must be ingested with lipids to be absorbed in
  the small intestine
• Stored in the liver and fat
• Can be removed from storage areas as needed
• Excess intake can lead to dangerously high levels

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Mineral Supplements Ferralyn

• Iron supplements - iron-deficiency anemia
• Calcium supplements - osteoporosis

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Minerals - Actions and Functions

• Ions in body fluid - sodium and magnesium
• Bind to organic molecules - iron and cobalt
• Function of many minerals is well known -
  calcium, sodium, potassium
• Functions of some of the trace minerals is less
  understood - aluminum, silicon, arsenic, nickel

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Mineral Excess

• Most minerals needed in very small amounts
• Obtained from a normal diet
• Excess minerals can be toxic
• Arsenic, chromium, nickel - human carcinogens
• Sodium - water retention and hypertension

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Enteral Nutrition

• Via the GI tract - orally or feeding tube
• Oral - natural digestive processes occur, less
  nursing care
• Tube feeding is necessary
• Difficulty swallowing
• Unable to take orally
• Advantage of tube feeding - intake can be
  precisely measured

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Enteral Products and Therapy

• Individual nutritional needs
• Examples - Vivonex, T.E.N., Peptamen Liquid,
  Sustacal Powder, Ensure, Casec, Polycose,
  Microlipid, and MCT Oil
• Start therapy slowly so adverse effects can be
  assessed

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Total Parenteral Nutrition (TPN)

• Via a vein
• Peripheral vein for short-term therapy
• Central vein for long-term therapy
• Bypasses GI tract so malabsorption diseases can
  be successfully treated

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Drugs for Endrocrine Disorders
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Type 1 Diabetes - Treatment

• Type 1 diabetes is treated with a combination of
  diet, exercise, and insulin
• Meals regularly, every 45 hours, to regulate
  blood glucose levels
• Regular, moderate exercise to help cells respond
  to insulin
• Insulin therapy to keep blood glucose levels
  within normal limits

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Type 2 Diabetes - Treatment

• Controlled through lifestyle changes and oral
  hypoglycemic agents
• Proper diet and exercise can sometimes increase
  sensitivity of insulin receptors

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Type 2 Diabetes - Treatment (contd)

• Oral hypoglycemic drugs
• When diet and exercise have failed to decrease
  the blood glucose
• Five classes of oral hypoglycemics
• Classifications based on chemical structure and
  mechanism of action
• Therapy initiated with a single agent
• Oral hypoglycemics are effective when taken on a
  regular basis

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Types of Hypothyroidism

• Cretinism - children
• Signs and symptoms of cretinism
• Dwarfism
• Severe mental retardation
• Myxedema - adults
• Myxedema - adults

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Types of Hypothyroidism (contd)

• Signs and symptoms of myxedema
• Slowed body metabolism
• Slurred speech
• Bradycardia, weight gain
• Low body temperature
• Intolerance to cold

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Hyperthyroidism - Too Much Thyroid Hormone
Secreted

• Graves disease - severe form of hyperthyroidism
• Signs and symptoms
• Increased body metabolism
• Tachycardia, weight loss
• High body temperature
• Anxiety

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Hyperthyroidism - Treatment

• Thyroidectomy if due to tumor
• Given antithyroid agents to kill or inactivate
  some of the thyroid cells, sometimes before
  thyroidectomy to decrease bleeding during surgery
• Ionizing radiation to kill or inactivate thyroid
  cells

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Insulin
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Table 29.2 Insulin Preparations
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Table 29.2 (continued) Insulin Preparations
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Oral Hypoglycemics
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Table 29.3 Oral Hypoglycemics
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Table 29.3 (continued) Oral Hypoglycemics
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Table 29.3 (continued) Oral Hypoglycemics
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Thyroid and Antithyroid Agents

• The correct dose is highly individualized
• Requires periodic adjustments

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Table 29.4 Thyroid and Antithyroid
Medications
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Hypothyroidism Slows the Bodys Metabolism

• Administration of thyroid hormone reverses that
  effect
• Treatment - Levothyroxine (Synthroid)

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Hyperthyroidism Speeds the Bodys Metabolism

• Administer drugs that kill or inactivate thyroid
  cells
• Antithyroid Agent - Propylthiouracil (Propacil)

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Antidiuretic Hormone

• Produced by the hypothalamus
• Secreted from the posterior pituitary gland
• Increases water absorption by kidneys
• Raises blood pressure if secreted in large
  amounts
• Diabetes insipidus - deficiency of ADH
• Treatment - Vasopressin (Pitressin)